Vocal cord nodules are thickenings on the edge of the vocal folds. They are also known as scream nodules, singer nodules, or vocal cord nodules. The thickened elevations are often mirror-image and comparable to the formation of calluses on normal skin. As a result of the nodules in the vocal folds, the vibration process on the mucous membrane of the vocal folds is disturbed. The normal closure of the vocal folds is also impaired.
What are vocal cord nodules?
Vocal cord nodules are among the so-called organic voice disorders. They form on the vocal folds and appear in the form of double-sided nodules. Corresponding nodules can form if the vocal folds are no longer able to vibrate freely as a result of mechanical overload. For what is liver cancer used for, please visit fun-wiki.com.
The initially soft nodules develop into hard thickening after prolonged stress. These form at the points that are under the greatest pressure when using the voice and are initially covered with mucous threads. Vocal fold nodules are an extreme form of what is known as hyperfunctional dysphonia.
They usually result in hoarseness and a hoarse voice with a constant need to clear your throat. Basically, vocal cord nodules only occur in women. Men, on the other hand, can only get so-called singer nodules, which mainly affect tenors.
Causes
Vocal cord nodules are the result of long-term overloading of the voice. Sometimes an unphysiological vocal technique is responsible for this overuse. But there are a number of other possible causes for the organic changes that show up on the vocal folds.
Overuse or misuse of the voice is usually the underlying cause of the formation of vocal cord nodules. This occurs, for example, in people who regularly speak in noise. Poor vocal technique results in speaking with an unusually high physical effort and pressure. Vocal fold nodules occur in singers in particular when they often sing in the wrong register and the voice is overwhelmed.
In this case, the vocal cord nodules are called singer nodules. In children, vocal cord nodules very often develop as a result of loud and frequent speech. Here the thickenings on the vocal cords are referred to as screaming nodules. In addition, people who are hard of hearing are often affected by vocal cord nodules because they often speak too loudly and put the wrong strain on their voice.
Symptoms, Ailments & Signs
The typical symptoms of vocal cord nodules can be varied and vary depending on the severity and location of the thickening on the vocal cords. In the majority of cases, vocal cord nodules are expressed by a hoarse and rough voice. Speaking is difficult, sometimes the voice fails.
Sometimes there is a foreign body sensation while speaking. In addition, many affected people have the urge to clear their throat frequently. In most cases, however, this does not help to reduce the discomfort in the vocal cords and the urge to clear your throat occurs again. As a result of the nodules in the vocal folds, the voice can be subjected to less and less strain.
The changes in the vocal folds form at their edges. Vocal fold nodules often occur in the transition area from the front to the middle third of the vocal folds. Here, when the mood is overloaded, a slight edema develops, which, however, subsides by resting the voice.
If the load continues, the edema increases. Soft nodules develop, which transform into hard nodules of the vocal folds if the strain continues. If the nodules are particularly large, a so-called hourglass glottis develops.
Diagnosis & course of disease
A number of examination methods and measures are available for the reliable diagnosis of vocal cord nodules. The doctor treating you decides on their selection after examining the individual case. In principle, it is advisable to consult an ear, nose and throat specialist if you suspect the presence of vocal cord nodules.
If possible, see a phoniatric doctor who specializes in voice disorders. In the course of a reflection of the larynx, the doctor is able to examine the vocal organ of the person concerned more closely. As a result, organic changes in the vocal folds, such as the formation of nodules, can be detected. In addition, the doctor recognizes the type of nodules present during the laryngeal endoscopy. The presence of soft or hard nodules allows conclusions to be drawn about the severity of the vocal cord nodules.
Complications
The foreign body sensation typical of vocal cord nodules means that those affected often clear their throat and thus put additional strain on the vocal cords. As the disease progresses, the voice can be less and less strained and occasionally inflammation or edema develop. If the load is not reduced, the edema increases – more nodules form and the symptoms increase.
In the case of particularly pronounced nodules, a so-called hourglass glottis can develop, a pathological change in the vocal cords. If left untreated, it can lead to complete loss of voice. There are usually no complications associated with the treatment of vocal cord nodules. In most cases, logopedic voice therapy is ordered, which can cause further problems if the diagnosis is incorrect. If painkillers or anti-inflammatories are prescribed for severe symptoms, problems can sometimes arise.
This can lead to side effects and interactions that cannot always be foreseen before taking the preparation. Typical complaints include gastrointestinal problems, cardiovascular problems or headaches and body aches. Patients who suffer from another disease or are already taking another drug are particularly at risk for possible interactions.
When should you go to the doctor?
As a rule, a doctor should always be consulted if there is a nodule in the vocal folds. Only an early visit to a doctor with subsequent treatment can prevent further complications or symptoms. Self-healing does not occur and symptoms worsen if vocal cord nodules are left untreated. A doctor should be consulted for this disease when the person affected can no longer speak easily. Speaking itself is usually difficult for the patient, which also leads to permanent hoarseness.
In many cases, people have to constantly clear their throat, which further damages the vocal cords. If these symptoms occur, a doctor must be consulted immediately so that the vocal cords are not further damaged by the vocal cord nodules. As a rule, the nodules in the vocal folds can be treated relatively well by an ENT doctor or by a general practitioner.
Treatment & Therapy
Treatment of vocal cord nodules depends on the consistency of the nodules present. In the case of soft nodules in the vocal folds, the doctor usually prescribes vocal rest. In speaking professions, this is often only possible by means of a sick note. In addition, logopedic voice therapy can be prescribed to reduce incorrect voice technique.
Since this is often associated with a longer absence from work, soft vocal cord nodules are increasingly surgically removed. Voice rest is also recommended for hard nodules. In most cases, the hard nodules of the vocal folds are removed by surgery.
The patient then undergoes logopedic voice training. The perception of one’s own voice and breathing is trained and the ability to hear is trained. The therapy is carried out by trained voice therapists, such as speech therapists or voice teachers.
Prevention
To prevent vocal cord nodules, regular rest of the vocal cords is recommended, especially for people in jobs where the voice is heavily used. Herbal remedies can be taken to calm the vocal cords.
Aftercare
With sufficient protection of the voice, vocal cord nodules regress on their own in most of those affected. Follow-up care is unnecessary here. In rare cases, the nodules are more pronounced or they do not regress on their own. Only then, at the discretion of the specialist, is an operation recommended. After that, as after any surgical procedure, follow-up treatment is usual in order to control the healing process.
If the symptoms do not improve in those affected, it is important to find other possible causes. These can be both physical and psychological. After the actual origin of the symptoms has been identified, it is treated as part of the aftercare.
In the case of vocal fold nodules, the patient can take follow-up measures himself. Loud talking should be avoided even after the nodules have healed. If, for professional reasons, it is not possible to do without frequent speaking, a microphone can help to protect the voice at a conference or similar occasions.
This will prevent knots from forming again. However, taking medicine is not necessary. Inhaling moisturizes the mucous membranes and protects them from drying out. This has a positive effect on the healing process and prevents irritation.
You can do that yourself
Rest is particularly advisable in the case of nodules in the vocal folds. Those affected should talk as little as possible for a few days. As a result, the hoarseness usually disappears by itself. However, if the typical symptoms occur again and again, a doctor should be consulted. Therapy then becomes inevitable.
If voice blockages and hoarseness develop from everyday work, patients should reconsider changing their job. Otherwise, people in speaking professions in particular would hardly be able to meet the respective requirements. It is also advisable to avoid nicotine and alcohol altogether. Spicy foods can also cause voice problems. Clearing the throat and whispering are considered strains on the vocal cords. Yawning, on the other hand, eliminates acute hoarseness and stretches the vocal folds. Regular breathing exercises and inhalations also restore the voice.
In the vast majority of all cases, the doctor orders speech therapy sessions. The therapists are trained to deal with the individual problem and to convey ways of acting for everyday life. Especially with chronic complaints, patients cannot avoid professional support. The question of whether surgical removal is necessary can also be discussed.
